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Immigration and Nationality Directorate
National Asylum Support Service
Block B, Whitgift Centre, Wellesley Road, Croydon CR9 1AT
Tel: 0845 602 1739; Fax: 020 8604 6908
Email: Section4@homeoffice.gsi.gov.uk

APPLICATION FOR SUPPORT UNDER SECTION 4

THIS IS AN APPLICATION FORM AND DOES NOT GUARANTEE SUPPORT UNDER SECTION 4 OF THE
IMMIGRATION & ASYLUM ACT 1999. THOSE REQUESTING SUPPORT MUST HAVE BEEN REFUSED
LEAVE TO REMAIN IN THE UK AS AN ASYLUM SEEKER. THEY MUST DEMONSTRATE THAT THEY
CANNOT NOW LEAVE THE UK AND ARE DESTITUTE. REQUESTS NOT ACCOMPANIED BY
SUPPORTING EVIDENCE ARE LIKELY TO BE REFUSED.

DATE OF APPLICATION:

APPLICANTS DETAILS:
NAME: D.O.B:
NATIONALITY: H.O. Ref:
NASS Ref. (if applicable):
CURRENT ADDRESS (including Tel No.):
REPRESENTATIVES DETAILS:
NAME: ORGANISATION:
ADDRESS:

TEL: FAX:
If support is provided any travel tickets should be sent to: Applicant/Representative
(Delete as appropriate)

I CONSIDER THAT I AM ELIGIBLE FOR SUPPORT UNDER SECTION 4 BECAUSE:
(Tick a box as appropriate)

I am destitute
(Note: You should use the space below to demonstrate that you are without adequate accommodation or the means of obtaining
it, or, if you have adequate accommodation, that you cannot meet your other essential living needs. If you have been without
support from NASS or a local authority for some time, you will be expected to explain how you have supported yourself during this
period.)


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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AND I SATISFY AT LEAST ONE OF THE CRITERIA LISTED BELOW:


I am taking all reasonable steps to leave the UK or place myself in a position to be able to leave.
(Note: You should provide information to support this, for example that you have made an application to the International
Organization for Migration for assisted voluntary return, or are complying with attempts to obtain any travel documents to facilitate
departure.)

I am unable to leave the UK by reason of a physical impediment to travel or for some other
medical reason.
(Note: Support will not be granted unless you provide medical evidence that clearly demonstrates you are unfit to travel to your
country and indicates, where possible, when you are expected to be fit to travel. Women in the late stages of pregnancy should
provide medical documentation stating their expected date of delivery. Women unable to leave the UK because they have a new-
born child should provide a birth certificate or medical documentation stating the childs birth date.)

I am unable to leave the UK because there is no safe route of voluntary return available.
(Note: You should indicate why you believe this to be the case.)

I have made an application for judicial review of a decision in relation to my asylum claim.
(Note: You should provide confirmation that you have applied for judicial review of a decision in relation to your asylum claim (in
Scotland), or that you have applied for judicial review of such a decision and have been granted permission to proceed (in
England and Wales) or granted leave (in Northern Ireland).

I require support in order to avoid a breach of my rights under the European Convention on
Human Rights.
(Note: Support will not be granted solely on the grounds that you are a failed asylum seeker and without access to support. You
must be able to demonstrate that it would not be reasonable to expect you to leave the UK, and that to remain in the UK without
support would result in a breach of your Convention rights. If you are unable to leave the UK because you have submitted further
representations which seek a fresh claim for asylum and these have not been considered, or because you have submitted an out-
of-time appeal to an appellate authority, you must provide copies of the representations or appeal forms. All applications for
support under this criterion will be considered on their merits. You should provide information on a separate sheet of paper and
submit it together with your completed application form and any supporting evidence. The fact that you may disagree with the
decision to refuse your asylum claim will not be taken into account when considering whether to provide support under section 4.)

If you meet these criteria and are provided with support under section 4, you must continue to meet
the criteria set out above in order to remain eligible for and be provided with support. If a decision is
taken not to provide you with support under section 4, or to discontinue that support on the grounds
that you are no longer eligible, you have a right of appeal to an asylum support adjudicator against
this decision under section 103(2A) of the Immigration and Asylum Act 1999.



CONDITIONS OF SUPPORT UNDER SECTION 4

If you are provided with support under section 4 you must comply with the conditions set out below. A failure
to comply with these conditions may result in the discontinuation of the support provided to you.

You may be required to participate in community activities. You are required to submit any
information regarding your suitability to participate in community activities in the Additional
Information part of this application form. If you are considered as suitable for the community
activities scheme, the provider of this scheme will visit you to make arrangements for you to
participate in activities. NASS will then notify you of these arrangements in writing, explaining
that the continued provision of your support is conditional upon you participating in these
community activities.

You must comply with standards of behaviour specified by your accommodation
provider, for example in an occupancy agreement, and must not commit acts of antisocial
or violent behaviour.

You must comply with any reporting requirement set by an Immigration Officer or the
Secretary of State.

You must reside at the accommodation provided to you and must not be absent without
permission from the accommodation for more than seven consecutive days and nights or
for more than a total of 14 days and nights in a six month period.
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You must comply with steps specified by the Secretary of State to facilitate your
departure from the UK. You will be required to comply with attempts by the Immigration Service
to return you to your country of origin, and to take all reasonable steps to obtain travel
documents to facilitate your departure. You will be notified in writing of the requirement to
comply with such specified steps. If you are eligible for support under section 4 because you
have applied for judicial review, submitted further representations seeking a fresh claim for
asylum or made an out-of-time appeal to an appellate authority, your continued support will not
be subject to this condition.

If a decision is taken to discontinue the support provided to you under section 4 as a result of a breach of
these conditions, you have a right of appeal to an asylum support adjudicator against this decision under
section 103(2A) of the Immigration and Asylum Act 1999.


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ADDITIONAL INFORMATION

You should set out below details of any circumstances that may affect your application for support, and
provide any supporting evidence. Such circumstances might include special accommodation requirements
due to care needs or a disability, or particular reasons why you should stay in the area where you are
currently living. You must also include details of your spouse or any other dependants included in your
application for support, including their name, date of birth, nationality, address and Home Office and NASS
reference numbers, if applicable. If the circumstances of your spouse or any other dependant differ from your
own, you must set this out clearly below. You should include any other information that you feel is relevant.





















You should set out below details of any circumstances that may affect your ability, or the ability of any
dependant aged over 18 years, to participate in community activities. You should provide any relevant
supporting evidence. If you are found to be eligible for support under section 4, NASS will have regard to this
information in determining whether your continued support should be conditional on your participation in
community activities. You should provide

details of your caring responsibilities for a child or dependant who because of a physical or
mental impairment is unable to look after him- or herself;
medical evidence of a physical or mental impairment or some other medical reason which would
make you unable to participate in community activities;
any other information that you feel is relevant to your suitability to participate in particular tasks
or activities.
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SUPPORT UNDER SECTION 4 ACCEPTANCE FORM

In order that NASS can promptly arrange accommodation for you if your application for support under section 4
is successful, please complete and return the acceptance form below. Your application for support will not be
considered unless this acceptance form has been properly completed.


To: National Asylum Support Service

In submitting this application for support under section 4 I understand that I am also accepting the
conditions under which this support is provided.

I understand the criteria for eligibility for support under section 4, and that I must continue to meet at
least one of these criteria to remain eligible for and be provided with support.
I understand the conditions under which support under section 4 is provided and that I may receive
a notice stating that I am required to participate in community activities as one of these conditions. I
understand that such a notice will notify me of the arrangements for my participation in community
activities, including details of the place, nature and duration of the activities. I also understand that
should I fail to comply with any of these conditions the support provided to me may be discontinued.
I understand that should a decision be taken to provide me with support under section 4 it may be
necessary for me to relocate to another area to access this support.
I understand that I must inform NASS of any change in my circumstances, and must comply with any
reasonable request to provide information while I continue to receive support.
I understand that my dependants, if I have any, may also be provided with support under section 4
subject to the same conditions as myself. If any of the conditions on the continued provision of
support to my dependants vary from my own, those conditions shall be set out separately to them in
writing.


Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .